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Musculoskeletal > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

A systemic skeletal disease characterised by:

  • low bone mass
  • micro-architectural deterioration of bone tissue

Resulting in bone fragility and susceptibility to fracture

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2
Q

List the classic fracture sites associated with osteoporosis?

A

Hip
Wrist (Colle’s fracture)
Vertebral

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3
Q

What is a Colle’s fracture?

A

A wrist fracture, often occurs after a fall on outstretched hand

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4
Q

Who gets osteoporosis?

A

Women much more than men

People over age 50
Prevalence increases with age

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5
Q

What are the risk factors of osteoporosis?

A

SHATTERED mnemonic

S - steroid use
H - hyperthyroid, hyperparathyroid
A - alcohol
T - thin
T - testosterone, low levels
E - early menopause
R - renal or liver failure
E - erosive inflammatory bone disease (RA)
D - dietary, low calcium or diabetes
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6
Q

Why does menopause cause osteoporosis?

A

Menopause = oestrogen depletion

Oestrogen usually restrains osteoclast action

No oestrogen means no restraint

The osteoclasts go mad and resorb more bone than they should

Osteoblasts can’t keep up with the osteoclasts

Net loss of bone

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7
Q

Why does inflammatory disease like RA cause osteoporosis?

A

Pro-inflammatory cytokines increase bone resorption

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8
Q

What endocrine diseases cause osteoporosis?

A

Hyperthyroidism + hyperparathyroidism
Thyroid and parathyroid hormone increase bone turnover

Cushing’s
Cortisol increased bone resorption AND induces osteoblast apoptosis

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9
Q

What causes decreased skeletal loading?

A

Lower weight

Immobility

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10
Q

Which drugs increase the risk of osteoporosis?

A

Steroids
Depo-Provera: a contraceptive
Aromatase inhibitors
Androgen deprivation

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11
Q

How do steroids increase the risk of osteoporosis?

A

Interfere with osteoblasts making them slower at making new bone

Interfere with body’s handling of calcium

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12
Q

What 3 things contribute to bone strength?

A
  1. Bone mineral density
  2. Bone size
  3. Bone quality
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13
Q

What 3 things contribute to bone quality?

A
  1. Bone turnover (clasts + blasts)
  2. Architecture
  3. Mineralisation
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14
Q

What is meant by ‘quiescence’ in the context of bones?

A

Stability, an equal balance between bone resorption and formation

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15
Q

What do osteoblasts do?

A

Form new bone

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16
Q

What do osteoclasts do?

A

Resorption (digestion) of bone

17
Q

What happens to the trabeculae in osteoporosis?

A

Decrease in trabecular thickness

Loss of horizontal trabeculae

Decrease in strength of trabeculae

18
Q

What is trabecular tissue?

A

The criss-cross network of thin extensions within bone

19
Q

How is osteoporosis picked up?

A

Patients usually present following a fracture

They are tested for osteoporosis

20
Q

Investigations of osteoporosis?

A

DEXA scan: looks at bone density, and from this given a T score

Blood:

  • Calcium
  • Phosphate
21
Q

What is a DEXA scan?

A

Dual Energy X-ray absorptiometry

Measures how much X-ray has been lost as it travels through the bone
The more X-rays picked up on the other side, the less structure of the bone is left

22
Q

Which areas should you scan in a DEXA scan?

A

The bones most at risk:

  • hip
  • spine
  • distal radius
23
Q

What is a T score?

A

A score calculated by comparing the result of the DEXA scan with the score of a gender matched young adult average

I.e. How much bone density have they lost since they were 20?

24
Q

What classifications are given using the T score?

A

Normal
Osteopenia
Osteoporosis
Severe osteoporosis

25
Q

What is osteopenia?

A

Lower than normal bone density but not severe enough to be osteoporosis yet

26
Q

What lifestyle measures should you advise patients with osteoporosis to take?

A

Quit smoking
Reduce alcohol
Light exercise
Calcium and vit D rich diet or supplements

Fall prevention strategies
- home modification

27
Q

Management of osteoporosis?

A

Lifestyle measures

Drugs:

  • anti-resorptive
  • anabolic
28
Q

What two classes of drugs do we use to treat osteoporosis?

A

Anti-resorptives: decrease osteoclast activity and bone turnover

Anabolic: increase osteoblast activity and bone formation

29
Q

Name some anti-resorptive drugs classes.

A

Bisphosphonates
Hormone replacement therapy
Denosumab

30
Q

Which drug is the first line choice for treating osteoporosis?

A

Bisphosphonates

31
Q

How do the bisphosphonates work?

A

They inhibit an enzyme in the chilsterol synthesis pathway

This interferes with the modification of prenylated proteins

Which means the osteoclasts don’t have the ruffled border they need to resorb bone

32
Q

What is the suffix of the bisphosphonates?

A

-dronate

33
Q

What type of drug is denosumab and how does it work?

A

A biologic

Its a monoclonal antibody to RANK ligand. Which binds to RANK preventing osteoclasts getting activated so they can’t resorb bone

34
Q

Name an anabolic drug used to treat osteoporosis?

A

Teriparatide

35
Q

How does teriparatide work?

A

Builds back bone where the bone had been lost

It improves the trabecular structure too

36
Q

What is hormone replacement therapy?

A

A treatment given to relieve the symptoms associated with menopause

Restores the natural female hormones: oestrogen and progesterone

37
Q

What are the symptoms of menopause?

A 
Hot flushes 
Night sweats   
Vaginal dryness  
Loss of libido 
Stress incontinence 
Osteoporosis
38
Q

What are the benefits of HRT?

A

Reduces risk of fractures
Stops progression of osteoporosis
Prevents menopausal symptoms
Reduces risk of colon cancer

39
Q

What are the risks of HRT?

A 
Breast cancer
Stroke
CVS disease
DVT
Vaginal bleeding

Musculoskeletal (15 decks)

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